Preoperative diastolic function predicts the onset of left ventricular dysfunction following aortic valve replacement in high-risk patients with aortic stenosis

INTRODUCTION: Left ventricular (LV) dysfunction frequently occurs after cardiac surgery, requiring inotropic treatment and/or mechanical circulatory support. In this study, we aimed to identify clinical, surgical and echocardiographic factors that are associated with LV dysfunction during weaning from cardiopulmonary bypass (CPB) in high-risk patients undergoing valve replacement for aortic stenosis. METHODS: Perioperative data were prospectively collected in 108 surgical candidates with an expected operative mortality ≥ 9%. All anesthetic and surgical techniques were standardized. Reduced LV systolic function was defined by an ejection fraction <40%. Diastolic function of the LV was assessed using standard Doppler-derived parameters, tissue Doppler Imaging (TDI) and transmitral flow propagation velocity (Vp). RESULTS: Doppler-derived pulmonary flow indices and TDI could not be obtained in 14 patients. In the remaining 94 patients, poor systolic LV was documented in 14% (n = 12) and diastolic dysfunction in 84% of patients (n = 89), all of whom had Vp <50 cm/s. During weaning from CPB, 38 patients (40%) required inotropic and/or mechanical circulatory support. By multivariate regression analysis, we identified three independent predictors of LV systolic dysfunction: age (Odds ratio [OR] = 1.11; 95% confidence interval (CI), 1.01 to 1.22), aortic clamping time (OR = 1.04; 95% CI, 1.00 to 1.08) and Vp (OR = 0.65; 95% CI, 0.52 to 0.81). Among echocardiographic measurements, Vp was found to be superior in terms of prognostic value and reliability. The best cut-off value for Vp to predict LV dysfunction was 40 cm/s (sensitivity of 72% and specificity 94%). Patients who experienced LV dysfunction presented higher in-hospital mortality (18.4% vs. 3.6% in patients without LV dysfunction, P = 0.044) and an increased incidence of serious cardiac events (81.6 vs. 28.6%, P < 0.001). CONCLUSIONS: This study provides the first evidence that, besides advanced age and prolonged myocardial ischemic time, LV diastolic dysfunction characterized by Vp ≤ 40 cm/sec identifies patients who will require cardiovascular support following valve replacement for aortic stenosis

A comparison of multiple Rosetta data sets and 3D model calculations of 67P/Churyumov-Gerasimenko coma around equinox (May 2015)

We have used the latest available shape model for gas and dust simulations of the inner coma of comet 67P/Churyumov-Gerasimenko for the period around May 2015 (equinox). We compare results from a purely insolation-driven model with a complementary set of observations made by ROSINA, VIRTIS, MIRO, and OSIRIS within the same period. The observations include - for the first time - inverted MIRO measurements of gas density, temperature and bulk velocity to constrain the model. The comparisons show that, as in November 2014 (Marschall et al., 2016), insolation-driven activity does not provide an adequate fit to the data. Both VIRTIS and MIRO observations indicate that emissions from the Hatmehit and Imhotep regions of the nucleus are strongly depleted in total gas, H2O, and dust emissions in this case. The MIRO inversion provides a challenging constraint to the models as a consequence of the terminator orbit and nucleus pointing of the spacecraft. Nonetheless a consistent picture with a dominance of outgassing from the Hapi region, even at equinox, is clearly evident. An inhomogeneous model consistent with models proposed for the November 2014 time-frame was constructed and provides a better fit to the data. As far as we are aware this is the first time comae data from four Rosetta instruments have been used to constrain within one self-contained model the emission distribution at the nucleus surface and study the dynamics of the gas and dust outflow

Regional unit definition for the nucleus of comet 67P/Churyumov-Gerasimenko on the SHAP7 model

Open Acces publication. This article is available under the Creative Commons CC-BY-NC-ND license and permits non-commercial use of the work as published, without adaptation or alteration provided the work is fully attributed.The previously defined regions on the nucleus of comet 67P/Churyumov-Gerasimenko have been mapped back onto the 3D SHAP7 model of the nucleus (Preusker et al., 2017). The resulting regional definition is therefore self-consistent with boundaries that are well defined in 3 dimensions. The facets belonging to each region are provided as supplementary material. The shape model has then been used to assess inhomogeneity of nucleus surface morphology within individual regions. Several regions show diverse morphology. We propose sub-division of these regions into clearly identifiable units (sub-regions) and a comprehensive table is provided. The surface areas of each sub-region have been computed and statistics based on grouping of unit types are provided. The roughness of each region is also provided in a quantitative manner using a technique derived from computer graphics applications. The quantitative method supports the sub-region definition by showing that differences between sub-regions can be numerically justified.© 2018 The AuthorsThe team from the University of Bern is supported through the Swiss National Science Foundation and through the NCCR PlanetS. The project has also received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement No 686709. This work was supported by the Swiss State Secretariat for Education, Research and Innovation (SERI) under contract number 16.0008-2

Regional unit definition for the nucleus of comet 67P/Churyumov-Gerasimenko on the SHAP7 model

The previously defined regions on the nucleus of comet 67P/Churyumov-Gerasimenko have been mapped back onto the 3D SHAP7 model of the nucleus (Preusker et al., 2017). The resulting regional definition is therefore self-consistent with boundaries that are well defined in 3 dimensions. The facets belonging to each region are provided as supplementary material. The shape model has then been used to assess inhomogeneity of nucleus surface morphology within individual regions. Several regions show diverse morphology. We propose sub-division of these regions into clearly identifiable units (sub-regions) and a comprehensive table is provided. The surface areas of each sub-region have been computed and statistics based on grouping of unit types are provided. The roughness of each region is also provided in a quantitative manner using a technique derived from computer graphics applications. The quantitative method supports the sub-region definition by showing that differences between sub-regions can be numerically justified

On understanding multi-instrument Rosetta data of the innermost dust and gas coma of comet 67P/Churyumov-Gerasimenko - results, strengths, and limitations of models

Numerical models are powerful tools for understanding the connection between the emitted gas and dust from the surface of comets and the subsequent expansion into space where remote sensing instruments can perform measurements. We will present such a predictive model which can provide synthetic measurements for multiple instruments on board ESA's Rosetta mission to comet 67P/Churyumov-Gerasimenko (hereafter 67P). We will demonstrate why a multi instrument approach is essential and how models can be used to constrain the gas and dust source distribution on the surface

Regional unit definition for the nucleus of comet 67P/Churyumov-Gerasimenko on the SHAP7 model

The previously defined regions on the nucleus of comet 67P/Churyumov-Gerasimenko have been mapped back onto the 3D SHAP7 model of the nucleus (Preusker et al., 2017). The resulting regional definition is therefore self-consistent with boundaries that are well defined in 3 dimensions. The facets belonging to each region are provided as supplementary material. The shape model has then been used to assess inhomogeneity of nucleus surface morphology within individual regions. Several regions show diverse morphology. We propose sub-division of these regions into clearly identifiable units (sub-regions) and a comprehensive table is provided. The surface areas of each sub-region have been computed and statistics based on grouping of unit types are provided. The roughness of each region is also provided in a quantitative manner using a technique derived from computer graphics applications. The quantitative method supports the sub-region definition by showing that differences between sub-regions can be numerically justified

Surgical treatment of complications associated with the Angio-Seal vascular closure device

Vascular closure devices are used to provide quick hemostasis and early ambulation after percutaneous interventions. The Angio-Seal (AS) vascular closure device forms a mechanical seal by closing the puncture site located between a bioabsorbable anchor within the lumen and a collagen sponge on the adventitia. Although morbidities associated with AS are reportedly infrequent, even the slightest inaccuracy in device implantation may result in displacement of these device components, leading to sudden and severe complications. We report the surgical treatment of complications associated with the use of AS in four patients, including acute limb ischemia, pseudoaneurysm formation, significant hemorrhage, and hypovolemic shock. A common factor in all these cases was that the components of the AS device were displaced from their original site of implantation, stressing the importance of proper device placement. All patients underwent successful surgical vascular repair. Our report highlights the need for exercising extreme care during device implantation, and also the requirement for vigilant inspection for any associated vascular complications commencing immediately after device implantation. It is vital that these device components are actively looked for and removed during surgical exploration so as to prevent future complications